| NPI | 1245036953 |
|---|---|
| Doing Business As | SQUARE LAKE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | BRANDON SAM KHADDOR Dentist/Partner 586-804-8118 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2025-02-22 |
| Last Update Date | 2025-02-22 |